Unless otherwise noted, all forms are in MS Word format. They can be opened immediately for printing or a right click and choice of "Save Target As" will allow saving of the document to your hard drive for later use. 

• Absent Parent Search Form

• Adoption Assistance Cover Sheet (doc)

• Adoption Assistance Renegotiation Request (doc)

• Adoption Assistance Request (doc)

• Adoption Assistance Yearly Contact

• Adult Fatality Review form (.doc)

• Adult Fatality 4th Level Review Protocol (.doc)

• Annual FP Approval Letter (Sample Letter) (.doc)

• Annual FP Hold Letter  (Sample Letter) (.doc)

• APS Confirmation Notice for Do Not Resuscitate (DNR) letter (.doc)

•  APS Do Not Resuscitate DNR form and  guidelines (.doc)

• APS Do Not Resuscitate DNR protocol (.doc)

• APS HIPAA Letter for Release of Information (.doc) Signed by General Counsel.  Note: Use the tab key when entering provider information

• APS Report not Accepted (Sample Letter) (.pdf)

• APS Results of Investigation (Sample Letter)

• Bed Hold Request sample form

• Biological Parent Search Results (doc)

• Case Transfer form (.doc)

• CHFS Out-of-Home Care Service Plan for Physical Health

• CHFS-005 Request for Authorization of Out-of-State Travel

• CHFS 219 Employee Confidentiality and Security Agreement on Internet/Intranet, Email, and Electronic Policies and Procedures

• CHR-101 Receiving Report and Authorization for Payment

• CHR-156 Request for Purchase

• Comprehensive Family Plan

• Concurrent Planning Handbook

  • Concurrent Planning Screening Matrix

• Confidentiality Agreement (.doc)

• Confirmation Notice For DNR (doc)

• Court Report Outline (doc)

• CPS HIPAA Letter for Release of Medical Information (.doc) Signed by General Counsel.  Note: Use the tab key when entering provider information

• CRP-001 Residential Application for Level of Care Payment (doc) (Incorporated)

• CRP-002 Private Child Care Notice of Level of Care Payment (doc) (Incorporated)

• CRP-003 Foster Care Application for Level of Care Payment (doc) (Incorporated)

• CRP-004 Notice of Level of Care Redetermination (doc) (Incorporated)

• CRP-005 DCBS Foster Care Utilization Review Notice of Level Assignment (doc)  (Incorporated)

• CRP-006 PCC Reassignment Form (doc)

• CRP-QA 100 Fax Notification Cover sheet (.pdf)

• CRP-QA 101 Exit Interview DCBS Staff Memorandum (.pdf)

• CRP-QA 102 Report of Suspected Maltreatment form (.pdf)

• CRP-QA 103 Report of Harm to Self or Others (.pdf)

• CRP-QA 200 Review Tool Overview

• CRP-QA 200 Review Tool

• CRP-QA 200 Review Tool Criteria

• CRP-QA 305-E Special Exit Request form (.pdf)

• Daily Record of Events (DROE) (.doc)

• DCBS and PCC Adoption Standard of Practice, PCC Adoption Invoice (MS Excel)

• DCBS Checklist

• DCBS-1 Informed Consent and Release of Information and Records (Word)

• DCBS-1 Informed Consent and Release of Information and Records  (Excel)

• DCBS-1  (Spanish) Informed Consent and Release of Information and Records

• DCBS-1A Informed Consent and Release of Information and Records Supplement

• DCBS-1A  (Spanish) Informed Consent and Release of Information and Records Supplement

• DCBS-2 Release of Information For Photograpy, Videotaping or Audiotaping

• DCBS-83 Acceptance Scale

• DCBS - 84 Child's Profile for Adoption Matching

• Division of Child Care  Forms

•           DCC-85 Approval for Child Care Assistance

•           DCC-86 Referral for Low Income Child Care Assistance

•           DCC-87 Change Record for Child Care Assistance Forms

•           DCC-91B DCBS Client Fact Sheet

•           DCC-112 Selecting Quality Child Care For My Child

•           DCC-113 Child Care Assistance Program Information for Workers

•           Daily Co-Payment Chart

•           Procedural Instructions for Child Care Assistance Forms

•           Income Eligibility by Family Size & Poverty Level (2008)      

• Division of Printing Order Form

• DNR Request Form Guidelines (doc)

• Domestic Violence Determination (pdf)

• DPP-AC-1 Transmittal Memorandum for Presentation Summary (doc)

• DPP-010 Open Records Request  (doc)

• DPP-20 Utilization Review Consult Form

• DPP-33 Education Assistance Authorization Form (doc)

• DPP-098 Student Intern Volunteer Application (doc)

• DPP-103 Tuition Assistance Application (doc)

• DPP-104A Request For Approval As Medically Fragile (doc)

• DPP-104B Medically Fragile Individual Health Plan  (doc)

• DPP-104C Medically Fragile Monthly Report (doc)

• DPP-105 Medical Information on the Child's Birth (doc) (Incorporated)

• DPP-106A Authorization for Medical Treatment (doc)

• DPP-106B Initial Health History Interview with Family (doc)

• DPP-106C Child Medical History and Annual Physical Exam (doc)

• DPP-106D Medical Appointment (doc)

• DPP-106E Dental Care (doc)

• DPP-106F Visual Screening (doc)

• DPP-106G Mental Health Services (doc)

• DPP-106H Prescription and OTC Medical Administration Record (doc)

• DPP-106I Methamphetamine Exposure and Medical Evaluation and Follow-up Form

• DPP-106J Child/Youth Immunization Record

• DPP-107 Health Information Required for Resource Home Applicants or Adult Household Members (doc) (Incorporated)

• DPP-108 Health Information Required for Resource Home Applicants Regarding Dependent Children (doc) (Incorporated)

• DPP-108A Health Information Required for Proposed Adoptive Parent(s) (doc) (Incorporated)

• DPP-109 DEPPB Investigative Report Request

• DPP-111 Foster Home Contract  (doc)

• DPP-111 (Spanish) Foster Home Contract

• DPP-111A Resource Home Contract Supplement (doc)

• DPP-111A (Spanish) Resource Home Contract Supplement

• DPP-111B Service Supplement Assessment (.doc) (Incorporated)

•                  Memo of justification to accompany the DPP-111B (.doc)

•                  Supplement Log to accompany the DPP-111B (.doc)

• DPP-112A Placement Exception Request (doc)(Incorporated)

• DPP 112-B Foster Parent Exception Plan (doc) (Incorporated)

• DPP-114 Private Child Caring and Child Placing Level of Care Schedule  (doc)

• DPP-115 Confidential Suspected Abuse/Neglect, Dependency or Exploitation Reporting Form

• DPP-117 Verification Request for Marriage and Divorce (doc)

• DPP-125 Consent For Voluntary Random Drug Testing (doc)

• DPP-126 DCBS Drug Test Collection Request Form (doc)

• DPP-130 Care Plus Daily Record of Events (DROE)

• DPP-152 CPS Substantiated Investigation Notification Letter (doc) (Incorporated)

• DPP-152 (Spanish) CPS Substantiated Investigation Notification Letter

• DPP-152A CPS Unsubstantiated Investigation Notification Letter (doc)

• DPP-152A (Spanish) CPS Unsubstantiated Investigation Notification Letter

• DPP-152B CPS Substantiated Investigation Notification Letter (School) (doc)

• DPP-153 CPS Family In Need of Services Assessment Notification Letter (doc)

• DPP-153 (Spanish) CPS Family In Need of Services Assessment Notification Letter

• DPP-153A CPS Family Not In Need of Services Assessment Notification Letter (doc)

• DPP-153A (Spanish) CPS Family Not In Need of Services Assessment Notification Letter

• DPP-153A (Arabic) CPS Family Not In Need of Services Assessment Notification Letter (pdf)

• DPP-154 Service Appeal Request (doc) (Incorporated)

• DPP-154 (Spanish) Service Appeal Request

• DPP-154A Notice of Intended Action (doc) (Incorporated)

• DPP-154A (Spanish) Notice of Intended Action

• DPP-155 CAPTA  Appeal (doc) (Incorporated)

• DPP-155 (Spanish) CAPTA Appeal

• DPP-156 Registry Check Form (doc) ((Incorporated)

• DPP-156 (Spanish) Central Registry Check (doc)

• DPP-157 Child Abuse or Neglect Check (doc)

• DPP-159 Criminal Records Check Authorization (doc)

• DPP-165 Permanency Hearing Notification (doc)

• DPP-167 Consent to Voluntary Commitment (doc)

• DPP-170 Financial Statement - Resource Parent Applicant (doc)

• DPP-171 Notice of Confidentiality (doc)

• DPP-187 Independent Adoption Application (doc) (Incorporated)

• DPP-188 Registration of Foreign Adoption (doc) (Incorporated)

• DPP-190 Information to be Obtained from Proposed Adoptive Parent(s) (doc) (Incorporated)

• DPP-190A Supplemental Information to be Obtained from the Proposed Adoptive Parent(s) (doc) (Incorporated)

• DPP-191 Information to be Obtained from the Placing Parent (doc) (Incorporated)

• DPP-191 (Spanish) Information to be Obtained from the Placing Parent

• DPP-191A Information to be Obtained from the Placing Parent for Independent Adoptions (doc)

• DPP-191A (Spanish) Information to be Obtained from the Placing Parent for Independent Adoptions

• DPP-192 Biological Parent Consent Form (doc) (Incorporated)

• DPP-192 (Spanish) Biological Parent Consent Form

• DPP-193 Adoptive Review Committee Comments (doc)

• DPP-195 Adoptive Placement Agreement (doc)

• DPP-196 SNAP Referral (doc)

• DPP-196A Individualized Recruitment Plan (doc)

• DPP-196B Update to SNAP Referral (doc)

• DPP-196C SNAP Withdrawal form (doc)

• DPP-197 Adult Child Interview (doc) (Incorporated)

• DPP-198 Foster Parents Statement of Intent to Adopt (doc)

• DPP-199 Independent Adoption Home Study Outline (doc) (Incorporated)

• DPP-201 Planned Permanent Living Arrangement (PPLA) Worksheet

• DPP-215 Consent to Adoption (doc)

• DPP-293, Adult Personal Development Plan (doc)

• DPP-294, Individual Adult Safety Plan (doc)

• DPP-333 Tuition Waiver for Foster and Adopted Children (pdf) (Incorporated)

• DPP-334 Request for Educational and Training Voucher Funds (doc) (Incorporated)

• DPP-335 Monthly Academic Standing and Enrollment Verification (doc) (Incorporated)

• DPP-601 Disability Determination IV-E Continuance Adoption Assistance (doc)

• DPP-886 Private Child Care Client Inter-Agency Referral Form (doc) (Incorporated)

• DPP-886A Application for Referral and Needs Assessment (doc)

• DPP-888 Annual Audited Cost Report & Time Study (AACRTS) (Incorporated)

•                          Instructions for completing AACRTS

•                          Time Study Codes for AACRTS

• DPP-1020, Safety Net Assessment

• DPP-1021, Safety Net Verification

• DPP-1022, Safety Net Report (MS Excel)

  • DPP-1022 Safety Net Report Example (MS Excel)

  • Example 628 for Safety Net Referral (MS Excel)

• DPP-1258 Adoption Assistance Agreement

• DPP-1258A Adoption Assistance Agreement Non-Recurring Adoption Expenses

• DPP-1258B Adoption Assistance Annual Contact Form

• DPP-1268, Medical Information for Newborn Infants

• DPP-1275 Relative Exploration Form (doc)

• DPP-1276 Relative Home Evaluation  (Incorporated)

• DPP-1285R Out-of-State Psychiatric Hospital/Residential Program Services Agreement

• DPP-1289 Annual Strengths/Needs Assessment for Resource Families (doc) (Incorporated)

• DPP-1290 Family Profile Cover Sheet (doc)

• DPP-1291 Resource Home Discipline Policy (doc)

• DPP-1293 Rehabilitative Services Plan of Care Approval

• DPP-1294 Rehabilitative Services Monthly Progress Report

• DPP-1299 (Referral for Emergency Weatherization Program)

• DPP-1300 SRA Service Complaint Monthly Report (MS Excel)

• DPP-1301 Validation Summary- 3rd Level Reviews

• Educational Passport (doc)

• Emotional Abuse Assessment Referral Form

• FAP-TRIS Foster/Adoptive Parent Informational Form (pdf)

• FAP-TRIS Foster/Adoptive Parent Intake Form (pdf)

• FAP-TRIS Foster/Adoptive Parent Update (pdf)

• FAP-TRIS Foster/Adoptive Parent Verification (pdf)

• FAP-TRIS Foster/Adoptive Parent Withdrawal (pdf)

• FAP-TRIS 1 Foster/Adoptive Parent Training Documentation (pdf)

• FAP-TRIS 1 Foster/Adoptive Parent Training Documentation Continuation Form (pdf)

• Foster Parents Statement of Intent to Adopt

• ICPC-100A Interstate Compact Placement Request

• ICPC-100B Interstate Compact Report on Child's Placement Status

• Individual Health Plan Part #1 (MS Excel)

• Individual Health Plan Part #2

• Individual Supervisory Consultation - Request

• Individual Supervisory Consultation - Provide

• Interim Policy and Procedure Letter 00-3

• Kinship Care

  • Region Log for Out-of-State Criminal Records Checks Form (MS Excel)

  • Kinship Care Regional Log for Start Up (MS Excel)

  • KC–01 KCP Statement of Rights and Responsibilities (Incorporated)

  • KC-01 (Spanish) Kinship Care Program Statement of Rights and Responsibilities

  • KC–02 Kinship Care Respite Request Form

  • KC–02A Kinship Care Respite Receipt Form

  • KC-14 Kinship Care Rights and Responsibilities  (Incorporated)

  • KIM-78KC Kinship Care Financial Assistance Application  (Incorporated)

  • Instructions for Completing KIM-78KC

  • Kinship Care Respite Request Log (MS Excel)

• KSP Request for Conviction Records/Adoptions and Foster Homes (Fingerprint Submission)

• MAP-620 Application for SCL Waiver and ICF/MR Services (pdf)

• Non-Recurring Adoption Expenses Application

• Notice APS Investigative Findings Adult Abuse, Neglect or Exploitation

• Notice of Amendment to Adoption Assistance Agreement

• Notice of Child Fatality or Near Fatality

• P&P-1282 Family Case Plan (pdf) (Incorporated)

• PCC Transportation Log

• Post-Legal Adoption Assistance

• Prevention Plan (Incorporated)

• Prevention Plan (Spanish)

• Private Child Care (PCC) Agreement

• Region Log for Kinship Care Start-Up (MS Excel)

• Request for Approval as Medically Fragile

• Request for Approval of Special Expense

• Request Form

• Sample Letter for Extension or Reinstatement of Commitment Agreement

• Sample Letter to Reimburse Attorneys Directly

• Sample Scripts for Internal Validation of Foster Parent or PCC

• Standardized Spouse/Partner Abuse Letter

• Standardized Spouse/Partner Abuse Letter  (Spanish)

• Statement of After-Placement Services

• Sub-Fund Monthly Reconciliation Statement (MS Excel)

• Supports for Community Living Program Visit - Review of Records and Facility Form

• Termination of Life Support Worksheet (.doc)

• Worker Checklist for DNR

• CHFS-300  Notice of Privacy Practices

• CFC-300  (Spanish) Notice of Privacy Practices Acknowledgement Cover Sheet

• CFC-301 Request for Client's Access to Protected Health Information (PHI)

• CFC-301 (Spanish) Request for Client's Access to Protected Health Information (PHI)

• CFC-302 Request for Amendment of Protected Health Information (PHI)

• CFC-302 (Spanish) Request for Amendment of Protected Health Information (PHI)

• CFC-303  Request to Restrict Protected Health Information (PHI)

• CFC-303 (Spanish) Request to Restrict Protected Health Information (PHI)

• CFC-304 Request for Accounting of Disclosures of Client's Protected Health Information (PHI)

• CFC-304 (Spanish) Request for Accounting of Disclosures of Client's Protected Health Information (PHI)

• CHFS-305  Authorization for Disclosure of PHI (Incorporated)

• CFC-305 (Spanish) Authorization for Release, Use or Disclosure of PHI

• CHFS-305A Authorization for Disclosure of Psychotherapy Information (Incorporated)

• CFC-305A  (Spanish) Authorization for Release, Use or Disclosure of Psychotherapy and/or Psychiatric Records

• CFC-306  Revocation of Authorization for Release, Use, or Disclosure of Health Information

• CFC-306 (Spanish) Revocation of Authorization for Release, Use, or Disclosure of Health Information

• CFC-307 Record of Verbal Agreement Concerning Protected Health Information (PHI)

• CFC-307 (Spanish) Record of Verbal Agreement Concerning Protected Health Information (PHI)

• CFC-308 Complaint Form For HIPAA Compliance OF Protected Health Information (PHI)

• CFC-308 (Spanish) Complaint Form For HIPAA Compliance OF Protected Health Information (PHI)

• CFC-309  Accounting of Disclosure Tracking Log